Salford Royal Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Our rating of effective stayed the same. We rated effective as requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The surgical services did not have effective systems and processes for assessing patients’ needs in the surgical wards. The services had planned improvements to spinal multidisciplinary team meetings, but these had not yet been fully implemented and embedded.

The national clinical audit findings showed clinical outcomes (such as mortality rates) for most patients were positive. However, the surgical services failed to meet standards relating to timely access to treatment across most national clinical audits.

Whilst staff followed national guidance to gain consent, audit records for consent, capacity and deprivation of liberty safeguards processes showed staff compliance was below trust targets.

However, clinical guidelines and pathways were based on national guidance. Staff advised patients on how to lead healthier lives.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We identified a regulatory breach around the timely assessment of patient’s needs during our previous inspection in September 2025. We found some improvements had been made during this inspection. However, audit records showed staff compliance was still below trust targets for nursing admission documentation, pressure care, bowel care, catheter care and local fasting guidelines for patients undergoing surgery.

The surgical wards achieved overall compliance of 64% for the hospital’s quality assurance (QAA) audit standard 31 (relating to the completion of nursing admission documentation) between February 2026 and May 2026. Whilst audit compliance had improved from 24% reported between June 2024 and September 2025, this was still below the trust’s 80% compliance target.

During February 2026 to May 2026, the QAA audit standard 56 (relating to catheter care) showed the surgical wards achieved compliance of 67% for documenting catheter insertion details, 66% for 3 times daily catheter monitoring and 69% for undertaking weekly catheter bag changes. This had improved from 50% compliance reported between June 2024 and September 2025 but was still below the target of 80%.

During February 2026 to May 2026, the QAA audit standard 57 (relating to bowel care) showed the surgical wards achieved compliance of 72% for daily bowel recording and 79% for undertaking diarrhoea assessments. This had significantly improved from 50% compliance reported between June 2024 and September 2025 but was still below the target of 80%.

During February 2026 to May 2026, the QAA audit standard 36 (relating to pressure care) showed the surgical wards achieved compliance of 89% for completion of risk assessment within 6 hours of admission, 58% for weekly risk reassessment, 70% for appropriate skin inspection, 74% for appropriate repositioning and 87% for appropriate use of pressure relieving devices. This had significantly improved from 21% compliance reported between June 2024 and September 2025.

The surgical services had adopted Sip Til Send guidelines since May 2025 for all adult surgical patients, with the exception of some high-risk procedures, such as upper gastrointestinal or bariatric surgery. A Sip Til Send audit undertaken during October 2025 reviewed 74 elective surgical patients to check compliance against local fasting guidelines. The audit showed only 32% compliance had been achieved, compared with the Centre for Perioperative Care (CPOC) compliance standard of 100%. Audit findings had been shared with staff to aid learning and improvement and a re-audit was planned to check if improvements had been made.

Admission policies were in place to provide guidance for staff around the assessments required on admission to the surgical services. Most patients we spoke with told us they had been assessed on admission, had regular reviews by the nursing and medical staff and that staff took into account their needs and preferences. Most of the care records we looked at across the surgical wards and theatres showed pre-operative assessments, risk assessments and care plans had been completed appropriately.

Patients were assessed by medical staff and advanced clinical practitioners. Daily medical ward rounds took place to assess patient’s needs. The services did not routinely undertake daily consultant-led ward rounds across all surgical specialties.

All new admissions were reviewed by a consultant followed by daily reviews by a registrar or above. A trust-wide 7 day services audit undertaken during 2024/25 identified shortfalls in consultant reviews undertaken within 14 hours of admission in the surgical services at this hospital. A further spinal surgery audit in May 2025 reviewed compliance against the Royal College of Physicians (RCP) guidelines for consultant reviews for emergency patients. The audit found 87% of patient had been reviewed by a consultant within 24 hours. An action plan had been developed to share audit findings and implement a documentation checklist to improve compliance.

The service had 24-hour access to mental health liaison and specialist mental health support teams. Staff understood how to seek guidance and advice to support patients with mental health concerns. We saw mental health assessments were completed appropriately in the care records we reviewed.

We scored the service as 3. The evidence showed a good standard. The service had systems and processes that were in line with legislation and current evidence-based good practice and standards.

Staff followed clinical guidelines and pathways that were based on national guidance, such as from The National Institute for Health and Care Excellence (NICE) and the Royal Colleges’ standards. We reviewed a number of care pathways, including for major trauma, spinal, head or brain injuries, intestinal failure or injury, general surgery and orthopaedic surgery and found these were based on national best practice guidance.

Emergency surgery was managed in accordance with the National Confidential Enquiries into Patient Outcome and Death (NCEPOD) recommendations and the Royal College of Surgeons standards for emergency surgery.

The surgical services had developed Local Safety Standards for Invasive Procedures (LocSSIPs) and implemented the principles of the National Safety Standards for Invasive Procedures (NatSSIPs).

A trust-wide weekly working LocSSIPs group was in place to review and harmonise LocSSIPs standards across the trust. The trust reported 71 LocSSIPs standards had been harmonised across all services (including surgery) and 31 additional standards were being reviewed. Records showed LocSSIPs standards for all relevant surgical pathways had been harmonised.

Staff used enhanced care and recovery pathways for a number of surgical specialties (excluding neurosurgery). Enhanced recovery is an evidence-based approach to delivering care in a way that promotes a better surgical journey and delivers a quicker recovery. The service had enhanced recovery after surgery (ERAS) nurse specialists in place to support people’s recovery following surgery.

We scored the service as 2. The evidence showed some shortfalls. Teams generally worked well together to support people. However, medical staff did not routinely attend daily board rounds, senior ward nurses did not routinely accompany medical staff on ward rounds, and improvements to spinal multidisciplinary team meetings had not yet been fully implemented or embedded.

During our previous inspection in September 2025, we reported that spinal multidisciplinary team (MDT) process improvements following the recommendations from spinal safety look back review (July 2023) had not yet been fully implemented. We found some progress had been made but the spinal MDT process was still not fully embedded during this inspection.

Spinal consultants told us the spinal MDT process was more effective, with improved attendance and greater confidence that eligible patients were reviewed and discussed at MDT. We observed a combined weekly spinal and spinal neurosurgical MDT meeting during the inspection. We found the meeting was well-attended and managed well. Key clinical information was discussed, with orthopaedic, microbiology, radiology and oncology input along with pre and post-operative review of all instrumented spinal cases and planned admissions. A permanent MDT coordinator had been appointed to facilitate the meeting and record meeting minutes.

There was a separate weekly neurosurgery MDT team meeting. Consultants told us the neurosurgery MDT also included some neurosurgery patients that required spinal surgery. We received conflicting information from spinal surgeons and neurosurgeons and found both groups had different interpretations about the inclusion of spinal surgical patients that overlapped across both specialties in the spinal MDT. Senior leaders told us discussions between the neuro and spinal specialty teams were ongoing to identify ways to ensure these patients were reviewed at the most appropriate MDT.

We saw there was daily communication between multidisciplinary teams across the service. Daily staff safety huddles and handover meetings took place to ensure all staff had up-to-date information about risks and concerns. We saw there was effective team working and communication between the theatre teams, including between surgeons and anaesthetists.

Most surgical wards carried out daily board round meetings, involving the flow coordinator, nurse in charge, pharmacy and therapy staff to review capacity and flow and identify and plan any patient discharges. However, we found medical staff did not routinely attend these meeting across the wards we inspected.

The ward staff told us they had a good relationship with consultants and ward-based doctors. The medical specialty doctors were not ward-based and reviewed patients across multiple surgical wards on a daily basis. Most of the surgical wards had patients from multiple surgical specialties, which meant different specialty medical teams attended the wards at different times during the day to review patients and conduct medical ward rounds. Senior ward nurses did not routinely accompany the medical staff during ward rounds. Some senior nurses and ward managers told us they did not always speak to the medical staff following their ward round but told us the medical staff would speak with them about changes to care and treatment for specific patients when required.

Service leaders told us they planned to trial a test of change project from June 2026 onwards to enable senior ward nurses to attend medical ward rounds.

Care records showed there was routine input from nursing and medical staff as well as specialist nurses and allied health professionals in the delivery of patient’s care and treatment. Patients told us staff worked well together as a team and their care and treatment was well coordinated.

Services such as diagnostic imaging, pharmacy, pathology and mental health liaison were available 7 days per week. Physiotherapy and occupational therapy support was available on weekdays and out of hours, with some onsite weekend priorities for respiratory therapist support across all wards, new admissions and discharges. Most other specialist support services (such as tissue viability, acute pain and speech and language therapy) were available during weekdays with on-call arrangements during out of hours and on weekends.

Staff told us they regularly engaged with teams and services across the trust’s other hospitals to plan and deliver services and share good practice and learning.

The implementation of the clinical leadership model (CLM) from April 2026 moved some surgical teams and services into integrated clinical service units and groups that functioned across the trust’s other hospitals. Staff told us this had created opportunities to engage with teams and services across the trust’s other hospitals to plan and deliver services and to share good practice and learning.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Health promotion information was displayed on notice boards and in information leaflets that were readily available across the areas we inspected. Patients could be referred to specialist support with smoking cessation or alcohol or drug abuse.

People identified with weight concerns were given advice on healthy eating and were referred to dietitians or signposted to specialist support services.

Patients told us they could access information around healthier living. Staff told us they routinely discussed health promotion and lifestyle choices with patients.

Staff were able to give examples of how they supported patients. This included wellbeing advice and discussions around healthier choices with exercise and health promotion. Staff told us discharged patients could be referred to specialist community teams for emotional support and therapy support to enable well-being and specialist support and exercise equipment to prevent patients from deconditioning following their hospital stay.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found during our previous inspection that the surgical services had failed to meet standards relating to timely access to treatment across most national clinical audits. We found some improvement had been made during this inspection, such as improvements in acute length of stay in the national hip fracture audit. However, the services still performed worse than national average for indicators relating to length of stay and timely arrival in theatres in the national emergency laparotomy audit and the national consultant information programme (NCIP) audits.

The surgical services participated in both national and local clinical audits. The surgical specialties at the hospital had been involved in 46 local audits and 26 national clinical audits during the current year. The services also reported outcomes data to databases such as the National Joint Registry (NJR), British Spine Registry (BSR) and the UK Shunt Registry (UKSR).

Findings from clinical audits were reviewed during routine clinical audit and governance meetings and any changes to guidance and the impact that it would have on their practice was discussed.

Outcomes for most people who used the service were positive, consistent and met expectations, such as national standards. The national clinical audit findings showed clinical outcomes (such as mortality rates) were within expected ranges across most clinical audits.

The surgical services at this hospital were within the expected range for the Summary Hospital-level Mortality Indicator (SHMI) and Hospital Standardised Mortality Ratio (HSMR) indicators.

Findings from the national hip fracture database audit, national emergency laparotomy audit, and national joint registry were published at hospital-level.

The 2025 national hip fracture database audit (based on 2024 data) showed the hospital performed better than national average for 4 indicators; patients documented not to have developed a pressure ulcer, patients not delirious when tested post-op eligible displaced intracapsular fractures treated with total hip replacement (THR) and for the provision of spinal anaesthetic and nerve block.

The hip fracture audit showed performance declined in 5 indicators, compared with the national average or the previous year’s audit (2024). This included physiotherapist assessment by the day after surgery (96.8% compared to 97.3% national average and 97.5% in 2024) and patients mobilised out of bed by the day after surgery (62.9% compared to 82% nationally and 65.4% in 2024). The audit indicator for documented final discharge destination scored 98.6% compared with 100% in 2024, but compliance was better than the 2025 national average (98.5%). The audit indicator for acute length of stay was 16.8 days. This had improved from 18.6 days in 2024 but was below the national average (15.5 days). The hospital performed similar to or better against national averages for all the remaining hip fracture audit indicators.

The 2025 national emergency laparotomy audit (NELA) (based on data for period between April 2023 and April 2024) showed the hospital performed similar to or better than national averages for most of the audit indicators. The audit showed the hospital performed worse than national average for 3 indicators, including risk documented pre-operatively and post-operatively, computed tomography (CT) scanning and reporting and arrival in theatre according to correct clinical timeframe.

The national joint registry (2025 data) showed mortality and revision rates for hip and knee replacements at the hospital were within expected ranges. NJR data showed the hospital performed worse than expected for trauma consent rate and elective consent rate between April 2025 and March 2026. The NJR data also showed the hospital performed better than expected for valid NHS number and within expected ranges for time taken to enter data during this period.

We looked at National Consultant Information Programme (NCIP) clinical audit data (2025) for a number of spinal procedures (such as posterior lumbar decompression, lumbar fusion surgery and anterior cervical spine procedures). These showed outcomes were comparable to national averages for most indicators, including for readmission rates. However, the services scored worse than national average in some audit indicators relating to patient length of stay.

Findings from the national bowel cancer audit and the national oesophago-gastric cancer audit were published at trust level and included data across the trust’s other hospitals.

The 2025 national oesophago-gastric cancer audit (based on data for the period between January 2022 and December 2023) showed the trust performed better than the national average for adjusted 90-day and 1-year postoperative survival rates.

The trust performed in line with national averages for most audit indicators in the 2025 national bowel cancer audit (based on 2022/23 data), including for adjusted 90-day mortality after major resection. The trust was identified as an alarm level outlier in 2025 national bowel cancer audit for the proportion of service users with an 18-month unclosed ileostomy (small intestine diverted through abdomen) after anterior resection. An action plan was in place to improve compliance and this was ongoing at the time of this inspection.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Audit records showed staff compliance for consent, capacity and deprivation of liberty safeguards processes was below expected trust targets.

Staff followed trust policies around consent and understood how to obtain informed verbal and written consent from people before providing care or treatment. Patients told us staff asked for their consent before delivering care and treatment.

The consent policy provided guidance for staff on how to obtain consent for care and treatment for adults and from young people aged 16 or over who received treatment in an adult healthcare setting. Staff understood how to seek consent from adults and young people (such as using the Gillick competence) when required.

The care records we looked at showed that written consent had been obtained from patients and planned care and treatment was delivered with their agreement. Consent records showed the risks and benefits of the specified surgical procedures were clearly documented and had been explained to patients.

The consent and operation note audit (2025) was based on a sample of 65 emergency procedures and 226 elective surgery procedures across the hospital. The audit showed high levels of compliance (94% and above) relating to documenting risks and benefits of the procedure and consent forms being signed by staff and patients. The audit also identified areas for improvement relating to staff recording their name, job title and documenting if written information had been provided. The audit results showed there had not been any significant improvement or deterioration in audit compliance since the previous consent audit undertaken in 2024.

Staff had policies in place and received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) as part of their mandatory safeguarding training.

The nursing and medical staff were trained to carry out mental capacity assessments to determine if a person had the capacity to make their own decisions. Patients identified with post-operative confusion or delirium were also assessed by the medical staff. Staff could seek support and guidance around consent, mental capacity and best interest decision making processes from the hospital-wide safeguarding team.

The trust’s enhanced patient observation (EPO) policy provided guidance for staff on assessing and monitoring patients identified at risk of harm. The policy stated that enhanced observation was regarded as a restriction or deprivation of liberty, a capacity assessment would be required if a person lacked the capacity to consent to stay in hospital, and a DoLS authorisation would need to be considered.

We looked at 6 enhanced observation care records, which showed capacity assessments had been completed, and multidisciplinary best interest meetings and decisions had been documented appropriately.

During February 2026 to May 2026, the hospital’s QAA audit standard 26 (relating to EPO documentation, mental capacity and behavioural charts) showed the surgical wards achieved compliance of 61% for accurate completion of EPO risk assessments, 83% for correct EPO alerts on patient boards and 97% for completion of hourly behavioural charts. This had significantly improved from 34% compliance reported between June 2024 and September 2025.

During February 2026 to May 2026, the hospital’s QAA audit standard 27 (relating to DoLS applications being completed and reviewed) showed the surgical wards achieved compliance of 87% for accurate completion of DoLS requests and 71% for accurate completion of DoLS extensions. This had improved from 67% compliance reported between June 2024 and September 2025.

Staff understood when it was appropriate to initiate DoLS authorisations. They were able to explain how they regularly reviewed and removed DoLS orders when no longer appropriate. We looked at 9 records where DoLS authorisations were in place, these were all completed appropriately and had been regularly reviewed to check they were still required.